Sunday, April 24, 2016

Differential Risk for Homelessness among US Male and Female Veterans with a Positive Screen for Military Sexual Trauma

IMPORTANCE:

Military
sexual trauma (MST) is associated with adverse physical and mental health
outcomes following military separation. Recent research suggests that MST may
be a determinant in several factors associated with post deployment homelessness.

OBJECTIVE:

To
evaluate MST as an independent risk factor for homelessness and to determine
whether risk varies by sex.

DESIGN, SETTING, AND PARTICIPANTS:

A
retrospective cohort study of US veterans who used Veterans Health
Administration (VHA) services between fiscal years 2004 and 2013 was conducted
using administrative data from the Department of Defense and VHA. Included in
the study were 601 892 US veterans deployed in Iraq or Afghanistan who
separated from the military between fiscal years 2001 and 2011 and subsequently
used VHA services.

EXPOSURE:

Positive
response to screen for MST administered in VHA facilities.

MAIN OUTCOMES AND MEASURES:

Administrative
evidence of homelessness within 30 days, 1 year, and 5 years following the
first VHA encounter after last deployment.

RESULTS:

The
mean (SD) age of the 601 892 participants was 38.9 (9.4) years, 527 874 (87.7%)
were male, 310 854 (51.6%) were white, and 382 361 (63.5%) were enlisted in the
Army. Among veterans with a positive screen for MST, rates of homelessness were
1.6% within 30 days, 4.4% within 1 year, and 9.6% within 5 years, more than
double the rates of veterans with a negative MST screen (0.7%, 1.8%, and 4.3%,
respectively). A positive screen for MST was significantly and independently
associated with postdeployment homelessness. In regression models adjusted for
demographic and military service characteristics, odds of experiencing
homelessness were higher among those who screened positive for MST compared
with those who screened negative (30-day: adjusted odds ratio [AOR], 1.89; 95%
CI, 1.58-2.24; 1-year: AOR, 2.27; 95% CI, 2.04-2.53; and 5-year: AOR, 2.63; 95%
CI, 2.36-2.93). Military sexual trauma screen status remained independently
associated with homelessness after adjusting for co-occurring mental health and
substance abuse diagnoses in follow-up regression models (30-day: AOR, 1.62;
95% CI, 1.36-1.93; 1-year: AOR, 1.49; 95% CI, 1.33-1.66; and 5-year: AOR, 1.39;
95% CI, 1.24-1.55). In the fully adjusted models, the interaction between MST
status and sex was significant in the 30-day and 1-year cohorts (30-day: AOR,
1.54; 95% CI, 1.18-2.02; and 1-year: AOR, 1.46; 95% CI, 1.23-1.74), denoting
higher risk for homelessness among males with a positive screen for MST.

CONCLUSIONS AND RELEVANCE:

A
positive screen for MST was independently associated with postdeployment
homelessness, with male veterans at greater risk than female veterans. These
results underscore the importance of the MST screen as a clinically important
marker of reintegration outcomes among veterans. These findings demonstrate
significant long-term negative effects and inform our understanding of the
public health implications of sexual abuse and harassment.